Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
-
Objective: To evaluate the effect of a Mobile Integrated Hospice Healthcare (MIHH) program including hospice education and expansion of paramedic scope of practice to use hospice medication kits. Primary outcome was the effect on hospice patient transport to the Emergency Department. Secondary outcomes included reasons for patient transport and review of MIHH kit utilization. ⋯ Conclusion: MIHH decreased the transportation of hospice patients to the ED. MIHH provided hospice education, provided family grief support and developed treatment plans with hospice nurses. An expanded scope of practice, including a paramedic hospice kit, was not contributory to this decrease.
-
Objective: Emergency medical service (EMS) transportation after acute stroke is associated with shorter symptom-to-arrival times and more rapid medical attention when compared to patient transportation by private vehicle. Methods: We analyzed data from the Paul Coverdell National Acute Stroke Program from 2014 to 2019 among stroke (ischemic and hemorrhagic) and transient ischemic attack (TIA) patients to examine patterns in EMS utilization. Results: Of 500,829 stroke and TIA patients (mean age 70.9 years, 51.3% women) from 682 participating hospitals during the study period, 60% arrived by EMS. ⋯ The decreasing trend was identified among ischemic stroke (p < 0.0001) patients but not among TIA (p = 0.89) or hemorrhagic stroke (p = 0.44) patients. There was no observed trend in pre-notification among stroke patients' arrival by EMS across the study period (56.9% to 56.5%, p = 0.99). Conclusions: Strategies to help increase stroke awareness and utilization of EMS among those with symptoms of stroke should be considered in order to help improve stroke outcomes.
-
Objectives: Environmental cleanliness of emergency ambulances may be associated with increased risk of healthcare acquired infection (HAI). Surface cleanliness, measured using adenosine triphosphate (ATP) testing, has been demonstrated to correlate with potentially harmful levels of microbial pathogens. In most ambulance services, environmental cleanliness of ambulances and the equipment within them is the responsibility of paramedics. ⋯ Conclusion: The innovative MRM cleaning system was associated with significantly improved cleanliness in frontline emergency ambulances. The magnitude of improvement in cleanliness suggests this cleaning model has the potential to make a major contribution to infection control strategies in paramedicine. Future research should focus on cost effectiveness of the MRM and its applicability to regional and remote ambulance service operations.
-
Objective: We sought to identify current Emergency Medical Services (EMS) practitioner comfort levels and communication strategies when caring for the Deaf American Sign Language (ASL) user. Additionally, we created and evaluated the effect of an educational intervention and visual communication tool on EMS practitioner comfort levels and communication. Methods: This was a descriptive study assessing communication barriers at baseline and after the implementation of a novel educational intervention with cross-sectional surveys conducted at three time points (pre-, immediate-post, and three months post-intervention). ⋯ Conclusions: The majority of EMS practitioners reported difficulty communicating with Deaf ASL users and acknowledged a sense of patient frustration. Nearly all participants felt the educational training was beneficial and clinically relevant; three months later, all participants found it to still be helpful. Additionally, the communication tool may be applicable to other populations that use English as a second language.
-
Context: As many as 14% of patients transported by ambulance with chest pain die prior to hospital discharge. To date, no high-quality controlled trials have revealed that prehospital advanced life support interventions affect survival for these patients. Objective: The Ontario Prehospital Advanced Life Support (OPALS) Study assessed the effect of adding an advance life support service to an existing basic life support emergency medical service program, on the rate of mortality and morbidity for patients with out-of-hospital chest pain. ⋯ We also demonstrated a decrease in mortality for the subgroup of patients with a discharge diagnosis of myocardial infarction (13.1 percent vs 8.2 percent, P = 0.002). Conclusions: The addition of a prehospital advanced life support program to an existing basic life support emergency medical service was associated with a significant decrease in the mortality rate among patients complaining of chest pain. Future research should clarify the most effective interventions and target specific populations.